P-026: FACTORS ASSOCIATED WITH RENAL DYSFUNCTION AMONG CHILDREN WITH SICKLE CELL DISEASE
Authors: JHANWAR M., JAIN D.
Journal: HemaSphere (2022)

Purpose: Sickle cell nephropathy is a major complication of sickle cell disease and microalbuminuria is an early predictor of renal damage. Hence it is important to study the prevalence of renal dysfunction and its associated clinical, biochemical, and nutritional factors, benefitting patients in early identification and appropriate intervention thus, preventing the renal complications and associated morbidity. Materials and methods: A cross sectional study was conducted considering a total of 163 patients between 5-20 years, with SCD (homozygous) of either sex, diagnosed using HPLC attending outpatient clinic in their steady state for routine clinical care at a tertiary care hospital. Patients with history of blood transfusion within 2 weeks or in acute crisis or febrile illness were excluded from the study. Random spot urine sample was used for estimation of microalbuminuria by immunoturbidimetry method. Demographic details, clinical, biochemical, and nutritional parameters of each were recorded, analysed and compared. Microalbuminuria was said to be present if urine albumin creatinine ratio was between 30-300 mg/gm urine creatinine and value more than 300 mg/gm of urine creatinine was labelled as macroalbuminuria. A positive screening test was repeated twice with an early morning urine sample before labelling patient as having microalbuminuria. eGFR estimation was done using modified schwartz formula. Results: Out of total 163 patients (5-20 years), majority (32.52%) were in the age group of 6.1-9 years followed by 5-6 years (31.29%). Male female ratio was 1.3:1. Mean BMI was 14.67 ± 2.32. Mean VOC episodes and mean number of blood transfusions were 3.25 ± 2.91 and 3.23 ± 4.39 respectively. 3 patients had macroalbuminuria (1.84%), microalbuminuria was found in 24 patients (14.72%) while 83.44% patients were normal. 71.8% patients had normal eGFR, 18.4% had hyperfiltration while 9.8% had mild decrease in eGFR. The mean age was significantly higher in children with microalbuminuria than in those without microalbuminuria (11.69 ± 3.86 vs 8.55 ± 3.59 years; P=0.001), youngest patient being 6-year-old. Amongst positive patients, 66.67% were males and 33.33% were females. However, no significant correlation was found between gender and microalbuminuria (P= 0.293). 70.8% of positive patients had ≥3 episodes of vaso-occlusive crisis during their lifetime (P= 0.028) which was found to be statistically significant. Blood pressure taken at first visit were within normal limits for all the patients. 75% patients were already on hydroxyurea at the time of enrolment. 16.67% patients with microalbuminuria had hyperfiltration, 12.5% had mild decrease in eGFR while 70.83% had normal eGFR. No significant correlation was found between patient’s eGFR, nutritional status, blood transfusion frequencies, acute febrile illness episodes or any laboratory parameters with microalbuminuria. Conclusion: Age and frequent episodes of vaso-occlusive crises were found to be major factors associated with occurrence of microalbuminuria. These results confirm the need for early screening of microalbuminuria in patients with sickle cell disease and will be helpful in designing target strategy for early identification and introduction of appropriate timely intervention (drugs like ACE inhibitors) so that long term renal complications can be prevented. The authors do not declare any conflict of interest